The association of carotid artery atherosclerosis with the estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults

Metabolic syndromes increase significantly with the accumulation of bad dietary habits

BACKGROUND

The association between dietary habits and metabolic syndrome (MetS) has not been well documented, due to the complexity and individualization of dietary culture in the Chinese population.

OBJECTIVE

To construct a composite score from various bad dietary habits and to evaluate their comprehensive association with the prevalence of MetS and its components among Chinese men and women across various age groups.

SETTING

Serial cross-sectional studies.

METHODS

Twenty-three dietary habits were assessed through face-to-face interviews with 98,838 males and 83,099 females in health check-up programs from 2015 to 2021, among which eighteen bad dietary habits were observed to be associated independently with total MetS. The total score of bad dietary habits was composed of four categories via variable clustering analysis, including irregular dietary habits, unhealthy dietary flavors, unbalanced dietary structure, and high-fat diet. The 2016 Chinese guideline for the management of dyslipidemia in adults was used to define MetS.

RESULTS

Men had a higher score of bad dietary habits than women (9.63 ± 3.11 vs. 8.37 ± 3.23), which decreased significantly with increasing age in both males and females (Pinteraction<0.01). The prevalence of total MetS increased significantly with the cumulative score of bad dietary habits in both males (highest quintile vs. lowest quintile: OR, 1.90; 95% confidence interval [CI], 1.80-2.00; Plinear<0.01) and females (OR, 2.23; 95% CI, 2.02-2.46; Plinear<0.01) after adjusted for age, education, smoking status, alcohol consumption, and physical activities. These linear trends were also observed for each MetS component (all Plinear<0.01). The role of irregular dietary habits and high-fat diet on MetS prevalence are much higher in males than in females, while unhealthy dietary flavors and unbalanced dietary structure had a greater influence on females.

CONCLUSIONS

The accumulation of bad dietary habits contributes to the MetS developments. Thus, individualized lifestyle interventions are needed to correct bad dietary habits with regard to gender differences.

Sodium intake and the risk of various types of cardiovascular diseases: a Mendelian randomization study

Background

The existing literature on the link between sodium intake and cardiovascular disease (CVD) largely consists of observational studies that have yielded inconsistent conclusions. In this study, our objective is to assess the causal relationship between sodium intake and 50 CVDs using two-sample Mendelian randomization (MR) analysis.

Methods

MR analyses were performed to investigate the associations between urinary sodium/creatinine ratio (UNa/UCr), an indicator of sodium intake, and 50 CVDs. The genome-wide association study (GWAS) for UNa/UCr was from the UK Biobank (UKBB), and the GWASs for CVDs were from FinnGen. A false discovery rate (FDR) threshold of 5% was applied for multiple comparison correction.

Results

The inverse-variance weighted method indicated that the genetically predicted UNa/UCr was significantly associated with 7 of 50 CVDs, including "Coronary atherosclerosis" (OR = 2.01; 95% CI: 1.37, 2.95), "Diseases of arteries, arterioles and capillaries" (OR = 1.88; 95% CI: 1.20, 2.94), "Hard cardiovascular diseases" (OR = 1.71; 95% CI: 1.24, 2.35), "Ischemic heart diseases" (OR = 2.06; 95% CI: 1.46, 2.93), "Major coronary heart disease event" (OR = 1.99; 95% CI: 1.36, 2.91), "Myocardial infarction" (OR = 2.03; 95% CI: 1.29, 3.19), and "Peripheral artery disease" (OR = 2.50; 95% CI: 1.35, 4.63). Similar results were obtained with the MR-Egger and weighted median methods. No significant heterogeneity or horizontal pleiotropy was found in this analysis.

Conclusion

Our study has uncovered a significant positive causal relationship between UNa/UCr and various CVDs. These results offer a new theoretical foundation for advocating the restriction of sodium intake as a preventive measure against CVD.

Impact of urinary sodium excretion on the prevalence and incidence of metabolic syndrome: a population-based study

OBJECTIVE

To evaluate the association of metabolic syndrome (MetS) risk with 24-hour urinary sodium excretion (24hUNaE) estimated from spot urine samples.

DESIGN

Serial cross-sectional studies were conducted, and those with multiple repeated examinations were used to assess the MetS incidence risk.

SETTING AND PARTICIPANTS

A health check-up programme was conducted between 2018 and 2021 and enrolled 59 292 participants to evaluate the relationship between MetS risk and 24hUNaE in the Third Xiangya Hospital, Changsha, China. Among these participants, 9550 had at least two physical examinations during this period, which were used to evaluate the association of a new occurrence of MetS with 24hUNaE.

OUTCOMES

Guidelines for the prevention and treatment of dyslipidaemia in Chinese adults (revised in 2016) were used to define prevalent and incident MetS.

RESULTS

The prevalence of MetS was 19.3% at the first check-up; among individuals aged ≤55 years, the risk was higher in men than women, while among older individuals, a similar prevalence was observed in both sexes. A significant increase in MetS prevalence was observed per unit increase in 24hUNaE (adjusted OR (AOR) 1.11; 95% CI 1.09 to 1.13), especially for the prevalence of central obesity and elevated blood pressure. Additionally, 27.4% of the participants among the 7842 participants without MetS at the first check-up (male vs female: 37.3% vs 12.9%) were found to have a new occurrence of MetS at the second, third and/or fourth check-ups. A 25% increase in MetS incidence was observed per unit increase in 24hUNaE (95% CI 1.19 to 1.32), which was more prominent in the participants with a new occurrence of central obesity and elevated fasting blood glucose.

CONCLUSIONS

Although the prevalence of MetS seemed stable, new occurrences of MetS remained high, which might result in MetS recurrence. The influence of sodium intake on MetS development is probably attributed to the increase in blood pressure and central obesity, but a new occurrence of MetS may develop through elevated blood glucose and central obesity.

The association of arterial stiffness with estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults

Arterial stiffness is an independent cardiovascular risk factor. However, the association between sodium/potassium intake and arterial stiffness in the Chinese population is unclear. Therefore, we performed a large, community-based cross-sectional study to reach a more definitive conclusion. The study was conducted at the Third Xiangya Hospital in Changsha between August 2017 and September 2019. Urinary sodium, potassium, and creatinine levels were tested from spot urine samples during physical examinations of each recruited participant. The 24-hour estimated urinary sodium excretion (eUNaE) and estimated urinary potassium excretion (eUKE) levels were calculated using the Kawasaki formula (used as a surrogate for intake). The brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were measured using an automatic waveform analyzer. In 22,557 subjects with an average age of 49.3 ± 10.3 years, the relationships of the ABI and baPWV with the levels of eUNaE, eUKE and the ratio of sodium to potassium (Na/K ratio) were analyzed. A significant negative relationship was found between the eUKE and baPWV levels (β = 2.41, p < 0.01), whereas the Na/K ratio was positively associated with baPWV (β = 2.46, p < 0.01), especially in the overweight and hypertensive populations (both pinteraction = 0.04). The association of eUNaE quartiles with baPWV presented a J-shaped curve after adjusting for confounders. In addition, a positive association was observed between the Na/K ratio and the ABI (β = 0.002, p < 0.01). In this study, high potassium and/or low sodium intake was further confirmed to be related to vascular stiffness in Chinese individuals.

The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population

Aims

A high intake of salt raises blood pressure and the risk of cardiovascular disease. Previous studies have reported on the association between salt intake and carotid stenosis, but the association with coronary atherosclerosis has not been reported. Therefore, this project aimed at studying the association between salt intake and both carotid and coronary atherosclerosis in a contemporary community-based cohort.

Methods and results

Estimated 24-h sodium excretion (est24hNa) was calculated by the Kawasaki formula for participants of two sites (Uppsala and Malmö) of the Swedish Cardiopulmonary bioImage Study, who underwent a coronary computed tomography (n = 9623) and measurement of coronary artery calcium score (CACS, n = 10 289). Carotid ultrasound was used to detect carotid plaques (n = 10 700). Ordered logistic regression was used to calculate odds ratios (OR) per 1000 mg increase in est24hNa. We also investigated potential J-formed associations using quintiles of est24hNa. Increased est24hNa was associated with increased occurrence of carotid plaques [OR: 1.09, P < 0.001, confidence interval (CI): 1.06-1.12], higher CACS (OR: 1.16, P < 0.001, CI: 1.12-1.19), and coronary artery stenosis (OR: 1.17, P < 0.001, CI: 1.13-1.20) in minimal adjusted models. Associations were abolished when adjusting for blood pressure. When adjusting for established cardiovascular risk factors (not including blood pressure), associations remained for carotid plaques but not for coronary atherosclerosis. There was no evidence of J-formed associations.

Conclusion

Higher est24hNa was associated with both coronary and carotid atherosclerosis in minimal adjusted models. The association seemed mainly mediated by blood pressure but to some degree also influenced by other established cardiovascular risk factors.

Late-Night Overeating or Low-Quality Food Choices Late at Night Are Associated with Subclinical Vascular Damage in Patients at Increased Cardiovascular Risk

Late-night overeating (LNO) is associated with several cardiovascular disease (CVD) risk factors. Limited data exist regarding the association between late-night (LN) systematic food consumption, LNO, and LN poor food quality with subclinical vascular damage (SVD) which precedes the onset of CVD. This study aimed to investigate the above associations with SVD in a large sample of adults, free of established CVD, with one or more CVD risk factors. In total, 901 adults (45.2% males) underwent anthropometric, dietary (through two 24 h dietary recalls) and vascular assessment. LN systematic eating was defined as consumption of food after 19:00 h in both dietary recalls and LNO was defined as systematic consumption of >40% of daily total energy intake (dTEI) after 19:00 h. Systematic LN food consumption was inversely associated with diastolic blood pressure (DBP) (−1.44 95% C.I. (−2.76, −0.12)) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, smoking, BMI and dTEI. LNO was positively associated with existence of carotid plaques (1.70 95% C.I. (1.07, 2.68)), while LN increased consumption of red meat, refined grains and wine and low consumption of whole wheat grains was positively associated with Aix (Augmentation Index) (0.84 95% C.I. (0.09, 1.59)), after adjusting for all the mentioned confounders. Systematic LN eating is associated with lower DBP while systematic LNO and consumption of poor-quality food late at night, is associated with SVD. Further research is needed to define more accurately the impact of LN eating habits on vascular health.

Application of a six sigma model to evaluate the analytical performance of urinary biochemical analytes and design a risk-based statistical quality control strategy for these assays: A multicenter study

Background

The six sigma model has been widely used in clinical laboratory quality management. In this study, we first applied the six sigma model to (a) evaluate the analytical performance of urinary biochemical analytes across five laboratories, (b) design risk‐based statistical quality control (SQC) strategies, and (c) formulate improvement measures for each of the analytes when needed.

Methods

Internal quality control (IQC) and external quality assessment (EQA) data for urinary biochemical analytes were collected from five laboratories, and the sigma value of each analyte was calculated based on coefficients of variation, bias, and total allowable error (TEa). Normalized sigma method decision charts for these urinary biochemical analytes were then generated. Risk‐based SQC strategies and improvement measures were formulated for each laboratory according to the flowchart of Westgard sigma rules, including run sizes and the quality goal index (QGI).

Results

Sigma values of urinary biochemical analytes were significantly different at different quality control levels. Although identical detection platforms with matching reagents were used, differences in these analytes were also observed between laboratories. Risk‐based SQC strategies for urinary biochemical analytes were formulated based on the flowchart of Westgard sigma rules, including run size and analytical performance. Appropriate improvement measures were implemented for urinary biochemical analytes with analytical performance lower than six sigma according to the QGI calculation.

Conclusions

In multilocation laboratory systems, a six sigma model is an excellent quality management tool and can quantitatively evaluate analytical performance and guide risk‐based SQC strategy development and improvement measure implementation.